51167L7 ce�i,-�4 s ,..2'j,, � LOT NO.
NO. STAEE.
ICATION FOR PLUMBING PERMIT
d r; OF CUPERTINO
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F 0 Sanitary No.
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° :i Date 96-? Permit No
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U Pee $ -3'=
2 LL
°4,plT�gtity�� h(►�q�gyc��}�g City of Cupertino Eor a permit to install plumbing
o pipand/or�Alxtuft4+-f lstEJ �'1'1lNAJreverse side hereof, and agrees to install said prices
> a and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
LL Use of Premises P S %C, Pv/ r -P /.t.✓-��w i-"�-Q --�� I
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o a Owners L . of 7wf Address
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� z By Yzt 612 1/ Sn -f'T (�/4r C�i rOWZfC` Address % rt- re q-'f��✓�i�P.
° CONTRACTOR, AGENT r--�
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a o State License �r V Approved
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PLUMBING INSPECTOR
FIXTURES
NUMBER
MAIN DRAIN
Storm n DraiFee
UNITS FEES
UNITS FEES
Water HeaterSize
Gas Fee
Water Closet
Material
Bath Tub
To Curb
Shower
To Prop. Line
Lavatories
To Existing
Kitchen Sink
Not Conn.
Dish Washer
Sewer Box
Waste Disposal,
Wash Tray
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
Bar Sink
' o in Drain
Comb.Sink & Tray
IT. Curb
Dental Unit
/
Drinking Fountain
al
Area Drain
Main Drain Fee
Water Leader
Storm n DraiFee
_Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
ac
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